Connecticut § 38a-478w Managed care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments.

Connecticut Statutes

§ 38a-478w — Managed care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments.

Connecticut·Title 38a Insurance·Ch. 700c Health Insurance

(a)For any contract delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2022, each managed care organization shall, when calculating an enrollee's liability for a coinsurance, copayment, deductible or other out-of-pocket expense for a covered benefit, give credit for any discount provided or payment made by a third party for the amount of, or any portion of the amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered benefit.

(b)The provisions of subsection (a) of this section shall apply to a high deductible health plan, as that term is used in subsection (f) of section 38a-493 or subsection (f) of section 38a-520 , as applicable, to the maximum extent permitted by federal law, except if such plan is

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(a) For any contract delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2022, each managed care organization shall, when calculating an enrollee's liability for a coinsurance, copayment, deductible or other out-of-pocket expense for a covered benefit, give credit for any discount provided or payment made by a third party for the amount of, or any portion of the amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered benefit. (b) The provisions of subsection (a) of this section shall apply to a high deductible health plan, as that term is used in subsection (f) of section 38a-493 or subsection (f) of section 38a-520 , as applicable, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code, as amended from time to time, the provisions of said subsection (a) shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223, as applicable.

Connecticut § 38a-478w (Managed care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Legislative History

(P.A. 21-14, S. 4; P.A. 22-146, S. 24.) History: P.A. 21-14 effective January 1, 2022; P.A. 22-146 designated existing language as Subsec. (a) and added Subsec. (b) re applicability to high deductible health plans, effective May 7, 2022, and applicable to contracts delivered, issued for delivery, renewed, amended or continued on or after January 1, 2022.